전신마취하 유방 양성 종양 수술 후 발생한 양안 급성폐쇄각발작

Bilateral Acute Angle Closure Crisis after General Anesthesia for a Breast Surgery

Purpose: To report a case of bilateral acute angle closure crisis after general anesthesia for a benign neoplasm of the breast surgery. Case summary: A 60-year-old female complained of bilateral ocular pain and visual disturbance after recovering from general anesthesia for wide excision of the left breast operation. Visual acuity was finger count and intraocular pressure (IOP) was measured as 50 mmHg in the right eye and 60 mmHg in the left eye. Slit lamp exam revealed cornea edema, conjunctival injection, and shallow central anterior chamber and narrow peripheral angle in both eyes. Acute angle closure crisis due to anesthetic agent was suspected. The symptoms improved after she was prescribed hypotensive eye drops, acetazolamide, and Osmotic diuretic medication. The next day of the surgery, IOP decreased to 10/10 mmHg and anterior chamber depth was 1.94 mm in the right eye and 1.88 mm in the left eye. Cup to radio was 0.6/0.7 in fundus photography and superotemporal and inferotemporal retinal nerve fiber layer defect was observed in the left eye using optical coherence tomography. Conclusions: It may be necessary to examine the patient for primary angle closure (PAC) and inspect the history of PAC even before non-ocular surgery, especially in patients with risk factors such as old age and female. Careful monitoring is required during the recovery of general anesthesia for ocular symptoms considering the possibility of bilateral acute angle closure crisis.